In May, the Asthma and Allergy Foundation of America (AAFA) released its annual Asthma Capitals list – which ranks the 100 largest U.S. cities by how problematic they are for people living with asthma.

Richmond ranked at No. 1, shooting up from spot No. 23 last year. Chattanooga came in second, worsening from last year’s fifth place position. Memphis, last year’s most challenging city in the U.S. to live with asthma, marginally improved, dropping to the third spot.

Tennessee was the only state to have three cities within the top 10, including two out of the top three, suggesting the state has much room for improvement for those living with asthma.

For two years running, San Francisco was ranked at No. 100, meaning it remains the least problematic of the 100 largest metro areas in the U.S. for people living with asthma.

In order to determine the ranking of the cities, 14 factors were examined. These included asthma prevalence, asthma death rate, pollen and air quality scores, ER visits for asthma, number of asthma specialists, and asthma medicine use.

Here are Top 10 2013 Asthma Capitals:

1. Richmond, VA

2. Chattanooga, TN

3. Memphis, TN

4. Philadelphia, PA

5. Oklahoma City, OK

6. Detroit, MI

7. Dayton, OH

8. McAllen, TX

9. Atlanta, GA

10. Knoxville, TN

Not surprisingly, there was some overlap between this list and the AAFA’s Spring Allergy Capitals list released in April. All but four of the top 10 asthma capitals were also found in the top 10 spring allergy capitals list. Chattanooga ranked in the top 3 for each list, suggesting it may be a very difficult place to live for people with asthma, environmental allergies, or other respiratory issues.

See AAFA’s Asthma Capitals List

Researchers have discovered that most adults with asthma who are sensitive to Aspirin also get mild to severe respiratory symptoms when drinking alcohol.

Dr. Tanya Laidlaw, of the allergic disease research center at Boston’s Brigham and Women’s Hospital, explained that Aspirin Exacerbated Respiratory Disease, or AERD, is a condition that involves three things: asthma, nasal polyps and a sensitivity to Aspirin (and other non-steroidal anti-inflammatory drugs or NSAIDS). AERD affects 10 to 20 percent of those with adult asthma.

She says her research team has now found that “three-quarters of all AERD patients do have respiratory reactions when they drink alcohol. For many of them, it’s within several sips of a single glass.”

Seventy-four percent were found to react to alcohol with an upper respiratory reaction, such as a runny nose or congestion, compared to 34 percent of a group with asthma who tolerate Aspirin.

Lower respiratory reactions, such as sometimes severe wheezing and shortness of breath, occurred in 51 percent of AERD patients after drinking alcohol, compared to 24 percent of the Aspirin-tolerant asthmatics.

What Causes Your Reaction to Alcohol?

The alcohol association arose initially from patients themselves. Laidlaw says patients at the AERD clinic at Brigham and Women’s Hospital were often mentioning symptoms like wheezing and coughing, signs of an asthma attack, when they drank alcohol. “They began asking: ‘Did we know why it was that when they had a glass of wine or a couple of beers, they would also have a very similar and often very severe respiratory reaction to the alcohol,’” she told a news conference.

She and her colleagues didn’t know, but were intrigued and decided this warranted study. The Brigham and Women’s center collaborated with the Scripps respiratory clinic in San Diego to send out a survey study to four groups: diagnosed AERD patients, patients who had asthma but are aspirin tolerant, patients with chronic sinusitis who don’t have asthma and to healthy patients with no asthma or sinus issues.

Among the patients reacting to alcohol, red wine emerged as the most likely to provoke symptoms (29 percent of patients), followed by beer (9 percent) and white wine or liquor (6 percent). However, for half of the patients, any kind of alcohol triggered symptoms.

This study of AERD patients and alcohol is continuing. So far, 132 patients have been recruited into the study, but researchers hope to expand this number to 320 before they finish.

Laidlaw notes that many AERD patients have had to stop drinking alcohol. The next step will be to examine what the mechanisms through which alcohol triggers such symptoms. Laidlaw says the relationship should also be useful in the diagnosis of AERD, which is not always obvious, as the sensitivity to Aspirin can be mild and is often overlooked.

See more news from the AAAAI 2013 conference here.

Read more about wine reactions here.

“We’ve shown that the gene being changed is directly associated with asthma and severity of the asthma,” Dr. Kari Nadeau of Stanford University, the senior study author, told a press conference at the 2013 meeting of the AAAAI in San Antonio, Texas.

The new study shows that exposure to polycyclic aromatic hydrocarbons (PAHs) in the air directly led to a change in a gene known as FOXP3. This gene exists inside regulatory T-cells, whose job is to suppress inappropriate immune responses, such as the airway inflammation associated with asthma. This alteration in the gene makes it harder for the T-regulatory cells to do their job, leading to worsened asthma symptoms.

The study also associated PAH exposure with higher overall levels of IgE antibodies, which play a major role in any allergic response.

For the study, researchers observed a group of children and teens at two sites in California: Fresno, which is known for heavy air pollution and a high rate of asthma (about 22 percent), while Stanford, a lower-pollution area, was used as a control group. Measurements were taken of PAH levels in the air, the children were given lung function tests, and also gave blood and urine samples.

The children who had been exposed to PAHs for three months before the testing were more likely to have altered FOXP3 genes, decreased T-regulatory cell function and high levels of IgE antibodies. All three differences make asthma more likely, and its impact more severe.

“Exposure to high PAH quantities may be having an effect at the molecular level, possibly leading to new cases of asthma,” said Nadeau in a press release. This altered version of FOXP3 was even found in individuals from the area who didn’t have asthma – and it is unknown whether this change is reversible.

More than 100 chemicals are classified as PAHs, which form when an organic substance is burned incompletely. Sources include oil, gas, coal, tobacco, or even meat from a barbecue (when drippings fall onto the flames, PAHs are formed which then adhere to the meat). Man-made PAHs can also be found – in tars as well as some plastics, dyes and pesticides.

See Allergic Living‘s full coverage of the 2013 AAAAI allergists conference.

NEW YORK (March 1, 2013) — Researchers at the Columbia Center for Children’s Environmental Health at the Mailman School of Public Health are the first to report an association between early childhood exposure to the chemical bisphenol A (BPA) and an elevated risk for asthma in young children. BPA is a component of some plastics and is found in food can liners and store receipts.

Results appear in the March edition of the Journal of Allergy and Clinical Immunology.

“Asthma prevalence has increased dramatically over the past 30 years, which suggests that some as-yet-undiscovered environmental exposures may be implicated. Our study indicates that one such exposure may be BPA,” says lead author Kathleen Donohue, MD, an assistant professor of Medicine at Columbia University College of Physicians and Surgeons and an investigator at the Center for Children’s Environmental Health.

Dr. Donohue and her co-investigators followed 568 women enrolled in the Mothers & Newborns study of environmental exposures. BPA exposure was determined by measuring levels of a BPA metabolite in urine samples taken during the third trimester of pregnancy and in the children at ages 3, 5, and 7. Physicians diagnosed asthma at ages 5 to 12 based on asthma symptoms, a pulmonary function test, and medical history. A validated questionnaire was used to evaluate wheeze.

After adjusting for secondhand smoke and other factors known to be associated with asthma, the researchers found that post-natal exposure to BPA was associated with increased risk of wheeze and asthma. BPA exposure during the third trimester of pregnancy was inversely associated with risk of wheeze at age 5. This unexpected finding is in contrast to the results of a previous study, which found that BPA exposure during the second trimester, a critical period for the development of airways and the immune system, was positively linked with risk for asthma.

Increased risk for wheeze and asthma was seen at “fairly routine, low doses of exposure to BPA,” says Dr. Donohue. “Like most other scientists studying BPA, we do not see a straightforward linear dose-response relationship.”

At all three time points, more than 90% of the children in the study had detectable levels of BPA metabolite in their bodies, a finding that is in line with previous research. This does not mean that they will all develop asthma, cautions Dr. Donohue. “Just as smoking increases the risk of lung cancer but not everyone who smokes gets lung cancer, not every child exposed to BPA will develop asthma.”

The biological mechanism behind the BPA-asthma connection is unclear. The current study found no evidence that exposure to BPA increased the risk that the immune system would develop more antibodies to common airborne allergens. “Other possible pathways may include changes to the innate immune system, but this remains an open question,” says Dr. Donohue.

The new study builds on existing evidence linking BPA exposure to respiratory symptoms, as well as to obesity, impaired glucose tolerance, and behavioral issues, among a range of health problems. In July, the Food and Drug Administration banned BPA in baby bottles and sippy cups.

Read more at http://ccceh.org/news/bpa-raise-risk-for-childhood-asthma

Up to 1,200 patients are enrolling in an international study to evaluate a new form of allergy immunotherapy which, if successful, will require as few as four allergy shots, given monthly, to rid a patient of an allergy to cat dander.

Current immunotherapy for cats takes about three years and often more than a hundred shots to complete.

“Use of immunotherapy has always been limited by the long treatment required,” said allergist Dr. Harold Nelson of National Jewish Health in Denver, who is heading the project. “If the current study confirms earlier findings, it could be a major step forward for allergy treatment,” he said in a news release.

With traditional allergy immunotherapy, multiple injections of protein triggers like cat dander or pollen are given in small then increasing amounts over a long period of time. The idea is to gradually build tolerance and, ultimately, to desensitize the patient to the allergen. While this type of vaccination is currently the only way to treat the underlying allergic disease (rather than just allergy symptoms), it is a fairly invasive, costly and time-consuming, since patients must make numerous visits to the doctor.

Cat allergy is one of the most common allergic disorders, and a frequent trigger for asthma. The protein in cat dander that causes almost all symptoms is “fel d 1”, and the new vaccination therapy, called ToleroMune, works by injecting seven tiny protein fragments or “peptides” of this cat protein, as opposed to the whole protein.

By using the fragments, which aren’t large enough to provoke an allergic reaction, studies to date show that patients can become desensitized to cat much more rapidly and with far few side effects. Unlike the proteins used in traditional immunotherapy, as the protein fragments are not large enough to cause a reaction.

The study is expected to involve about 1,200 participants at National Jewish Health as well as at more than 100 centers in the United States, Canada, and Europe. Researchers hope to confirm earlier findings which showed that after four shots of ToleroMune, which has been developed by the British firm Circassia Ltd., many patients became desensitized and remained so a year later.

According to a study presented by Dr. Leonard Bielory at the annual meeting of the American College of Allergy, Asthma and Immunology, pollen counts are expected to more than double by that year.

Bielory, who is a leading investigator of plants and climate change, explains that in the year 2000, pollen counts averaged 8,455. By 2040, they are predicted to reach 21,735.

To create these far-reaching forecasts, the Rutgers researchers study allergenic plants in special climate chambers that mimic future conditions.

Naturally, along with this news there was a related finding: the sneezing season will begin earlier every year.

Seven states and the District of Columbia have been named to AAFA’s Honor Roll this year. AAFA sends congratulations to: Connecticut, the District of Columbia, Indiana, Massachusetts, New Jersey, Rhode Island, Vermont and Washington.

Click through to AAFA’s site to view an interactive map and detailed reports for all 50 states and D.C., comprehensive reports for the Honor Roll states as well as study methodology.

Allergy Foundation Releases Annual “Fall Allergy Capitals” Rankings, Louisville is #1

WASHINGTON, Sept. 27, 2012 – Fall is a time to enjoy beautiful colors and autumn weather outdoors. But for 40 million Americans with seasonal allergies, this time of year brings an unwelcome harvest: trillions of pollen particles traveling through the air right into your eyes, nose and mouth. Allergic rhinitis – also called nasal allergies, seasonal allergies or hay fever – is among the most common chronic diseases for children and adults, affecting more than 12 percent of the U.S. population.

The primary fall allergy trigger – ragweed pollen – causes itchy runny nose, nasal congestion, repeated sneezing, watery eyes, inflamed sinuses and, in severe cases, difficulty breathing. It can be more problematic if you also have asthma.

The Asthma and Allergy Foundation of America (AAFA) recently announced its 2012 Fall Allergy Capitals™ ranking, and Louisville, Kentucky, tops the list as “the most challenging place to live with fall allergies.” The annual report names 100 U.S. cities based on an analysis of three factors including pollen, allergy medications usage and the number of allergy specialists per patient. See the full list at www.AllergyCapitals.com.

 The Top 10 Fall Allergy Capitals

“Everyone seems to be feeling allergies these days and fall is the most common allergy season after spring,” says Dr. Beth Corn, a Board Certified Allergist in New York City and a member of the American College of Allergy, Asthma and Immunology (ACAAI). “No matter if it’s men, women or children, in the city, suburbs or the country, allergies don’t discriminate,” says Corn.

However, AAFA is quick to remind that no matter what city you live in allergies can be a problem all year long, indoors as well as outdoors. According to Brian Oliver, a spokesperson for AAFA, “With a little bit of planning and some good cleaning habits, you can keep your home as allergy-friendly as possible.” AAFA offers these tips no matter where you live:

1. Keep windows and doors closed to prevent pollen from blowing into the house.
2. Control dust mites on the bed. Look for a Certified asthma & allergy friendly mattress, like the Breathe mattress from Spring Air, and wash sheets weekly in hot water (130 degrees F) to kill mites and their eggs.
3. Use a quality vacuum that has a high-efficiency filter weekly to keep indoor allergens to a minimum.
4. Change the air filter in your furnace regularly. Filters can trap lots of dust and allergens, so replace them every 30-90 days. Look for Certified asthma & allergy friendly filters, like Lysol brand air filters.
5. Reduce the presence of mold by decreasing moisture around the house, keeping humidity below 50% and clearing the yard of damp firewood and leaves.

About AAFA

AAFA is the leading patient organization for people with asthma and allergies in the U.S. The asthma & allergy friendly™ Certification Program is a joint project of AAFA and Allergy Standards Limited (ASL), an international research and testing organization. Learn more at www.aafa.org/certified.

]]> http://allergicliving.com/index.php/2012/10/09/aafas-fall-allergy-capitals-louisville-is-no-1/feed/ 0 http://allergicliving.com/index.php/2012/03/20/asthma-stays-with-you-for-life/ http://allergicliving.com/index.php/2012/03/20/asthma-stays-with-you-for-life/#comments Wed, 21 Mar 2012 01:53:23 +0000 Allergic Living http://allergicliving.com/?p=13016 A huge Canadian study shows that once you’re diagnosed with asthma, you’re very likely to be stuck with it for life.

The study tracked almost 614,000 province of Ontario residents who were identified as having asthma in 1993, following them for 15 years.

While some patients reported periods of disease inactivity, sometimes for years, most were managing their asthma most of the time. In the 15-year followup, 82.3 percent had active asthma.

“A lot of people have asthma and would like to know how their disease will affect them over time,” study lead author Dr. Andrea Gershon, a respirologist, said in a media release.

“These findings offer insight into the course of asthma activity and support the hypothesis that once a person has asthma, they will continue to have it for life.”

The study was conducted by researchers for the Institute for Clinical Evaluative Sciences (ICES) in Toronto, and was published in the Journal of Allergy and Clinical Immunology.

In the study, researchers followed 19,349 twins between the ages of 12 and 41. The lowest risk of asthma was found in the group that consumed one to six  “units” of alcohol per week. (One unit of alcohol is equivalent to half a pint of beer or about half a glass of wine.)

Teetotalers take note: those who drank rarely or never had the highest risk of developing asthma; they were 1.4-times as likely to get it. But moderation is key, since heavy drinkers were also at increased risk, at 1.2-times as likely to end up with the respiratory disease.

The results also show that a preference for drinking beer was associated with a higher risk when compared with no preference.